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    2020-08-18


    have been a factor, this finding was likely due to the fact that patients reported relatively good average pre-surgical QOL and swallowing function regardless of disease stage (Range = 84.11–88.93 out of 100 on the UWQOL , with higher scores indicating better QOL, and 80.04–88.11 out of 100 on the MDADI , with higher scores indicating better swallowing function). Future prospective investigations using larger and possibly more homogenous samples are needed to better clarify associations between QOL, dysphagia, and health service use in this population.
    Clinical implications
    Our findings suggest that QOL measures and PROMs, which are inexpensive and often quickly and easily administered, may be useful in predicting post-surgical health resource use. This underscores the im-portance of routinely collecting QOL and PROM data in clinical practice as they MK 2206 could complement other prognostic factors in the pre-operative setting. For example, pre-operative counseling with a speech-language pathologist (SLP) may lead to shorter hospital LOS and lower rates of hospital readmission after total laryngectomy. In addition to preparing patients to cope with the physiological and anatomical changes and possibly reducing anxiety, pre-operative visits with an SLP can also provide prophylactic intervention as appropriate and address current swallowing complaints that may or may not be resolved with surgery. These visits could also help set up a good rapport for post-operative therapeutic intervention and help the patient prepare for an earlier discharge by beginning the educational process of how to engage in post-operative self-management. In this sense, improved patient edu-cation in the pre-op setting could contribute to the reduced likelihood of ED visits and hospital readmissions that are related to patient self-care issues.
    Integration of QOL measures and PROMs in routine clinical care may also help identify which patients would benefit most from different treatment programs. Despite the fact that patients' subjective reports of their dysphagic symptoms do not always reflect the actual physiology of the swallow [56–58], patients who indicate that their swallowing function is compromised prior to surgery may benefit from more up front intervention. For example, based on this information the SLP could suggest possible behavioral interventions or compensatory stra-tegies to deal with the patient’s dysphagic symptoms while they wait for surgery. QOL measures and PROMs could also be used to identify pa-tients who are at risk for increased health service use so secretion can be targeted to improve discharge planning and coordination of hospital care. This information is valuable to clinicians who often place the focus of increased resource utilization on social, patient, and disease related factors despite data, which indicates that a large number of barriers to quality improvement initiatives for surgical patients center around institutional resources and providers themselves [59–61]. Therefore, inexpensive strategies are needed to identify patients at risk for increased health resource utilization, such as routine QOL and PROM evaluations. Such strategies have the potential to be accepted by providers, do not require significant institutional resources, and could potentially reduce health resource use in the HNC setting.
    Conflict of interest
    None of the authors have any actual or potential conflicts of interest including any financial, personal, or other relationships with other people or organizations within that could inappropriately influence their work.
    Acknowledgements
    This study was supported in part by a grant from the National Cancer Institute R21CA178478 (PI: Hoda Badr, PhD.) as well as use of facilities and resources at the Houston HSR&D Center for Innovations in  Oral Oncology 90 (2019) 102–108
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